2020
- Georgia Hate Crimes Bill 2019: HB 426; (passed 96-64) SB 166; 0
"Our forebears assumed everything gets better in time. That's obviously not true. If we stay silent for another generation, two other people will be sitting here in 50 years having the same conversation." Bryan Stevenson, EJI
HB426: http://www.legis.ga.gov/Legislation/en-US/display/20192020/HB/426
SB166: http://www.legis.ga.gov/Legislation/en-US/display/20192020/HB/426
- Pharmacy Benefit Manager Legislation: Putting Up Guardrails
SB313: http://www.legis.ga.gov/legislation/en-US/Display/20192020/SB/313
- Georgia New Medicaid Waivers
See CoverGA.org to review a summary of Georgia'a proposed 1115 Medicaid Waiver and 1332 Private Insurance Waiver and submit a comment to the Centers for Medicare & Medicaid Services.
- Surprise Billing Legislation
- Stop Tax on Menstrual Products
HB8: Georgia Menstrual Product State Sales Tax Exemption Bill
--> See the Georgia STOMP (Stop Tax On Menstrual Products) coalition factsheet on HB 8
2019
Opposing Senate Finance Committee Changes to Part D (July 12, 2019)
At the Advocates for Responsible Care (ARxC) and its health access project, Rx in Reach GA Coalition (Rx in Reach), we are committed to finding ways to reduce drug prices to help improve access and affordability to prescription drugs in Medicare Part D and commercial drug plans. With an increasing Medicare population and more adults and children needing vital medications to manage their serious chronic illnesses, the need to collaborate with industry, patient advocates and policymakers to reduce drug costs can only help to reduce high cost medical events while producing better health outcomes.
ARxC helped to roll-out Medicare Part D in Georgia. Medicare Part D is a highly successful program with 90% of seniors happy with it and premiums have remained lower than anticipated. One good change being proposed is an Out-of-pocket (OOP) cap for seniors; and this would be welcomed. It would set the out of pocket limit at about the same limit as when the catastrophic coverage kicks in (at about $2700).
However, we are alarmed by the dangerous changes The Senate Finance Committee is considering to the program:
- -Inflation penalty, which would jeopardize access to many from children to seniors. This penalty kicks in if the list price of a drug increases more than inflation. There is also a penalty that the manufacturer has to pay back to government. In theory, this sounds fine until you read the details. The penalty:
- -removes market based approach that’s made Part D so successful
- -is based on list price (not accurate price of what drug actually costs)
- -The list price changes, but net price has remained steady over the years
- -It can change month to month, just like inflation rate, so for planning purposes; it’s hard to determine if patients are going to face the penalty.
- -Hurts patients by denying access to life-saving medications. It gives big insurance more power to negotiate drug prices. ARxC and their health access project, Rx in Reach GA worked to get Step Therapy Reform passed in Georgia. These dangerous changes to Part D would mean even if a doctor prescribes a specific medication, patients will be required to spend time experimenting with medications that are less effective before and if, they would be allowed to get coverage for the more expensive vital drugs they need.
- -Further injures patients by not reducing their out-of-pocket costs.
- -Denies Medicare the ability to negotiate lower drug prices and allows insurance companies to deny coverage for essential medications.
The real winners in this plan are the insurance companies, and as patient advocates we feel strongly the insurance companies don’t need another win at the expense of seniors and Americans who need access to affordable drugs and care.
We implore the Senate Finance Committee to only make changes to Part D that will benefit patients like the out-of-pocket cap and reject changes that will hurt patient access like the inflation penalty and ‘step therapy’ like protocols.
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Pharmacy Benefit Managers Reluctant to use Reduced Code for Drug Pricing (June 27, 2019)
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ARxC Supported Legislation for January 9, 2017 - March 2017 Session.
Georgia Legislative Update: Sine Die - updated April 3, 2017
After the confetti flew, the House and Senate Chambers became quiet and the legislative session ended Friday, March 31, it was clear, bold legislative initiatives were lacking this year. There was disappointment over crucial pieces of legislation that did not pass.
SB 8: Surprise billing legislation | DID NOT PASS
Legislators failed to reach an agreement about how to best resolve the problem of surprise out of network billing for Georgia consumers. However, legislators committed to continuing their work on this issue by passing HR 745 which creates a study committee that will examine "surprise insurance gaps" and balance billing.
HB 188: Expand Medicaid NOW Act | DID NOT PASS
Sponsored by House Minority Leader Stacey Abrams, this bill was not expected to gain much traction because of the uncertain environment created by federal health care reform efforts. However, it calls attention to the need to provide health care coverage to the 300,000 Georgians who are stuck in our state's coverage gap because they do not currently qualify for Medicaid and cannot access health insurance through the Affordable Care Act's Marketplace.
HR 182 & SR 349: Resolutions supporting Medicaid block grants | DID NOT PASS
Both of these resolutions encouraged the restructuring of Georgia's Medicaid program from its current federal-state partnership structure to a block grant program. SR 349 urged the U.S. Congress to block grant funding for Georgia's Medicaid program and indigent care needs, while HR 182 provided legislative permission to the Governor and the Department of Community Health to seek per capita block grant funding for Medicaid. Shifting Medicaid to either a traditional or per capita block grant structure would result in cuts to services and beneficiaries, putting Georgia's most vulnerable children, parents, elderly, and people with disabilities at risk.
SB 4: Mental Health Treatment Task Force | DID NOT PASS
SB 4 establishes a task force that is charged with examining the current mental health landscape in Georgia, how Medicaid and other health care services provide the appropriate care for people with mental illness or substance use disorders, and determine what changes may need to be made in and outside of Medicaid to better address the mental health needs of Georgians.
What we did accomplish:
HB 276/SB 103: Pharmacy Patients Fair Practices Act | PASSED
HB 276 and SB 103 both regulate pharmacy benefit managers, which are third party companies that manage the prescription drug programs of many insurance plans. Both bills would prohibit PBMs from certain practices that limit consumer access and choice to preferred pharmacies and to lower cost drugs. Both bills passed their respective chambers. *This bill is important for patients and their physicians in deciding the best choice of treatment and to start to curb the high cost of prescription drugs.
HB 154: Oral health legislation | PASSED
This legislation allows for the "general supervision" of dental hygienists, which means hygienists can practice in safety net settings, school clinics, nursing homes, and private practices without a dentist being present.
SB 16: Medical marijuana access | PASSED
This legislation expands the list of conditions for which Georgians who have registered with the Department of Public Health may possess low THC oil. The newly added diagnoses include Alzheimer’s disease, AIDS, autism, epidermolysis bullosa, peripheral neuropathy and Tourette’s syndrome. Patients in hospice care may also possess the oil.
HB 249: Opioid crisis bill | PASSED
HB 249 moves the Prescription Drug Monitoring Program (PDMP) to the Department of Public Health from the Georgia Drugs and Narcotics Agency. HB 249 requires that all physicians register and consult the PDMP under certain prescribing conditions and that providers report certain benzodiazepine and opioid-based prescriptions to the database. The bill also requires the tracking and reporting of Neonatal Abstinence Syndrome and codifies the Governor’s emergency order on an overdose reversal drug (naloxone), making it available without a physician prescription.
SB 121: Access to opioid antagonists | PASSED
SB 121 codifies Governor Deal's executive order to allow consumers to access opioid antagonist drugs (e.g. Naloxone) over-the-counter without a prescription.
SB 180: Expansion of rural hospital tax credits | PASSED
After HB 54 failed to pass the House before Crossover Day, its language was amended to SB 180. The legislation expands the new rural hospital tax credit program from a 70% credit to a 90% credit, among other minor changes.
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Rx in Reach GA Coalition: HB 519: Step Therapy Bill| DID NOT CROSS OVER Requires health benefit plans to utilize certain clinical review criteria to establish step therapy protocols; to provide for a step therapy override determination process; to provide for definitions; to provide for statutory construction; to provide for rules and regulations; to provide for applicability; to provide for related matters; to repeal conflicting laws; and for other purposes. We will continue to push for this vital legislation. http://www.legis.ga.gov/legislation/en-us/display/20172018/hb/519
State budget includes important health items
The FY 2018 budget passed the House in mid-February and is now being considered by the Senate. As passed by the House, the budget includes increased Medicaid reimbursement rates for certain primary care codes and pediatric dental codes, which help to increase access to care for people with Medicaid coverage. The budget also includes funding for two new federally qualified health centers in Cook and Liberty counties. Additionally, the budget includes enhanced funding for supportive housing, an important determinant of health for people with behavioral health issues.
ALERT : Senate "Repeal and Replace" Task Force
Early in the legislative session, the Senate established a task force to address impacts to Georgia from any federal changes to the Affordable Care Act. This committee has convened twice, but has not yet scheduled a public meeting. It is unlikely to be a very active committee until there is clarity at the federal level about the direction of health care policy changes, and which provisions or concepts of the ACA will be kept or repealed.
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ARxC Supported Legislation for January 11, 2016 - March 24, 2016 Session.
SB 302: Insurance; require health carriers to maintain accurate provider directories: A BILL to be entitled an Act to amend Title 33 of the Official Code of Georgia Annotated, relating to insurance, so as to require health carriers to maintain accurate provider directories; to provide for definitions; to provide for electronic and printed provider directories; to require certain information in provider directories; to grant enforcement authority to the Commissioner; to provide for related matters; to repeal conflicting laws; and for other purposes. PASSED
HB 965: “The Honorable Jimmy Carter Cancer Treatment Access Act”: A BILL to be entitled an Act to amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to general insurance provisions, so as to provide that no health benefit plan shall require an insured to fail to successfully respond to a drug or drugs for stage four advanced, metastatic cancer prior to the approval of a drug prescribed by his or her physician; to provide for definitions; to provide for a short title; to provide for legislative findings and intent; to provide for related matters; to repeal conflicting laws; and for other purposes. PASSED
SR 974: Senate Surprise Billing Practices Study Committee; create A RESOLUTION creating the Senate Surprise Billing Practices Study Committee; and for other purposes. Senate Favorably Reported
SR 1043: Expansion on Autism Insurance Mandate; create Senate Study Committee: A RESOLUTION creating the Senate Study Committee on the Expansion of Autism Insurance Mandate to ERISA Plans; and for other purposes. Senate Favorably Reported
HB 768: Handicapped persons; ABLE program establishment to use tax exempt accounts to pay for qualified expenses of eligible individuals with disabilities; provisions: A BILL to be entitled an Act to amend Title 30 of the O.C.G.A., relating to disabled persons, so as to provide for the establishment of a qualified ABLE program in this state to enable the contribution of funds to tax-exempt accounts to pay for the qualified expenses of eligible individuals with disabilities; to amend Code Section 48-7-27 of the O.C.G.A., relating to computation of taxable net income; to amend Code Section 50-13-2 of the O.C.G.A., relating to the definitions for purposes of the Georgia Administrative Procedure Act, so as to exclude the Georgia ABLE Program Corporation from the meaning of “agency”; to provide for related matters; to provide for an effective date; to repeal conflicting laws; and for other purposes. PASSED by Substitute and Amended
HB 897: Health; care and protection of indigent and elderly patients; provide for the establishment and operation of a drug repository program to accept and dispense unused prescription drugs. A BILL to be entitled an Act to amend Chapter 8 of Title 31 of the O.C.G.A., relating to the care and protection of indigent and elderly patients, so as to provide for the establishment and operation of a drug repository program to accept and dispense unused prescription drugs; to amend Chapter 4 of Title 26 of the O.C.G.A., relating to pharmacists and pharmacies, so as to repeal the “Utilization of Unused Prescription Drugs Act”; to amend Article 7 of Chapter 4 of Title 49 of the O.C.G.A., relating to medical assistance generally, so as to revise a provision for purposes of conformity; to provide for related matters; to repeal conflicting laws; and for other purposes. PASSED by Substitute
SB 158: “Insurer Transparency Act”; provide certain consumer and provider protections regarding health insurance. A BILL to be entitled an Act to amend Title 33 of the Official Code of Georgia Annotated, relating to insurance, so as to provide certain consumer and provider protections regarding health insurance; to provide for definitions; to provide for short titles; to provide for health insurer transparency; to provide for health care providers’ right to choose; to provide for health care provider stability; to provide for consumer right to access; to provide for related matters; to repeal conflicting laws; and for other purposes. PASSED by Substitute
HB 919: Health; rural health care organizations which provide health care services to underserved areas; approve. A BILL to be entitled an Act to amend Titles 31 and 48 of the Official Code of Georgia Annotated, relating to health and revenue and taxation, respectively, so as to approve rural health care organizations which provide health care services to underserved areas in this state; to provide for definitions; to provide for tax credits for contributions to rural health care organizations; to provide for the amount, nature, limits, and procedures for such tax credits; to provide for related matters; to provide for applicability; to repeal conflicting laws; and for other purposes. House passed by Substitute
SB 368: Medical Assistance; eligible individuals to obtain health care coverage; provide program of premium assistance. A BILL to be entitled an Act to amend Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to medical assistance generally, so as to provide for a program of premium assistance to enable eligible individuals to obtain health care coverage; to provide for definitions; to require personal responsibility premiums from eligible individuals; to provide for a compliance pool; to provide for any necessary state plan amendments or federal waivers; to provide for termination of the program under certain circumstances; to provide for the Legislative Oversight Committee for Health Care Premium Assistance; to provide for related matters; to provide for an effective date; to repeal conflicting laws; and for other purposes. Bill did NOT cross over.
SB 382: “Surprise Billing and Consumer Protection Act”; provide for consumer protections regarding health insurance. A BILL to be entitled an Act to amend Title 33 of the Official Code of Georgia Annotated, relating to insurance, so as to provide for consumer protections regarding health insurance; to provide for definitions; to provide for disclosure requirements of providers, hospitals, and insurers; to provide for billing and reimbursement of out-of-network services; to provide for procedures for dispute resolution for surprise bills for nonemergency services; to provide for payment of emergency services; to provide for an out-of-network reimbursement rate workgroup; to provide for related matters; to repeal conflicting laws; and for other purposes. Bill did NOT cross over.
HB 875: “Patient Access to Specialty Tier Drugs Act”; enact A BILL to be entitled an Act to amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to insurance generally, so as to require issuers of health benefit policies to provide certain information to enrollees and establish certain processes and limits relating to specialty drugs; to provide for a short title; to define terms; to provide specific requirements for issuers; to provide for related matters; to repeal conflicting laws; and for other purposes. Bill did NOT cross over.
SB 245: Insurance; provide for access to opioid analgesics with abuse-deterrent properties; definitions. A BILL to be entitled an Act to amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to general provisions of insurance, so as to provide for access to opioid analgesics with abuse-deterrent properties; to provide for definitions; to provide for coverage as a preferred drug; to provide for utilization management; to provide for legislative findings; to provide for related matters; to provide for applicability; to repeal conflicting laws; and for other purposes. Bill did NOT cross over.
SB 299: Georgia Health Care Transparency Initiative; create; definitions; purpose. A BILL to be entitled an Act to amend Chapter 1 of Title 33 of the Official Code of Georgia Annotated, relating to general provisions of insurance, so as to create the Georgia Health Care Transparency Initiative; to provide for definitions; to provide for a purpose; to provide for a Georgia Health Care Initiative Board; to provide for the board’s membership and duties; to provide for the Commissioner’s duties; to provide for subcommittees; to provide for submission of data and its uses; to provide for data confidentiality; to provide for penalties; to provide for funding; to provide for related matters; to repeal conflicting laws; and for other purposes. Bill did NOT cross over.
HB 834: Health; establish charity care organizations for healthcare for the uninsured; provide tax credit. A BILL to be entitled an Act to amend Title 31 and Title 48 of the Official Code of Georgia Annotated, relating to health and revenue and taxation, respectively, so as to establish charity care organizations to provide health care services to the uninsured in this state; to provide for definitions; to provide for tax credits for contributions to charity care organizations; to provide for the amount, nature, limits, and procedures for such tax credits; to provide for related matters; to repeal conflicting laws; and for other purposes. Bill did NOT cross over.
HB 823: “Expand Medicaid Now Act”; enact. A BILL to be entitled an Act to amend Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to medical assistance generally, so as to provide for the authorization of appropriations for the purposes of obtaining federal financial participation for medical assistance payments to providers of Medicaid expansion under the federal Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010; to provide for a maximum percent of the federal poverty level; to provide for a short title; to provide for related matters; to repeal conflicting laws; and for other purposes. Bill did NOT cross over.
SB 38: Medicaid; authorization of appropriations; medical assistance payments to providers of Medicaid expansion. A BILL to be entitled an Act to amend Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to medical assistance generally, so as to provide for the authorization of appropriations for the purposes of obtaining federal financial participation for medical assistance payments to providers of Medicaid expansion under the federal Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010; to provide for certain restrictions; to provide for related matters; to repeal conflicting laws; and for other purposes. Bill did NOT cross over.
SB 364: A BILL to be entitled an Act to amend Article 6 of Chapter 2 of Title 20 of the Official Code of Georgia Annotated, relating to the "Quality Basic Education Act," so as to revise provisions relating to annual teacher, principal, and assistant principal evaluations; to revise provisions relating to student assessment; to provide for related matters; to repeal conflicting laws; and for other purposes. PASSED by Substitute
HR 1382: A RESOLUTION encouraging the Department of Community Health to create and seek the counsel of a State Health Benefit Plan Customer Advisory Council; and for other purposes. PASSED
HB 853: Bill will update the policy to reflect advances in stroke treatment and therapy. Specifically, it will add a third designation - Comprehensive Stroke Centers - to assure that stroke patients may be quickly identified and transported to facilities that have specialized programs for providing timely and effective treatment for stroke patients. PASSED House by Substitute; onto the Senate.

Analysis and Report to Inform Efforts to Promote Access to Affordable Prescription Drugs
In August 2016, consumer representatives to the National Association of Insurance Commissioners (NAIC) issued the Promoting Access to Affordable Prescription Drugs: Policy Analysis and Consumer Recommendations for State Policymakers, Consumer Advocates, and Health Care Stakeholders report. This report includes a series of recommendations to assist regulators, lawmakers, and the NAIC on ways to promote access, affordability, nondiscrimination, transparency, and meaningful oversight of prescription drug coverage. This report addresses state regulatory commissions power to monitor plans and adjust formulary design to reduce discrimination based on medical conditions. It also addresses Pharmacy Benefits Mangers role and oversight along with more transparency of drug formularies. ARxC and our fellow consumer representatives will continue to monitor the recommendations in this report for their discussion and implementation by the insurance industry. We thank our friends at Georgians for a Healthy Future for their vital contribution to this publication.
Specialty Tier Legislation
Insurance plans have traditionally included a three-tiered structure for prescription drugs - each with its own patient co-pay limits. Insurance companies are increasingly moving medications to "specialty -tiers" where there are no limits on what the patient is required to pay for their specialized medications.
ARxC and the Specialty Tier Coalition of Georgia put forward HB 875 or the Patient “Patient Access to Specialty Tier Drugs Act.” This bill was designed to amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to insurance generally, so as to require issuers of health benefit policies to provide certain information to enrollees and establish certain processes and limits relating to specialty drugs; to provide for a short title; to define terms; to provide specific requirements for issuers; to provide for related matters; to repeal conflicting laws; and for other purposes. Unfortunately this bill was not brought to hearring and did not cross over.
Go to www.rxinreachga.org/legislation/ to learn more about this bill and how you can get involved in securing access to vital drugs.
Support Part D Beneficiary Appeals Fairness Act
a) Substitution should occur only when the FDA has designated a biologic product as interchangeable.
b) The prescribing physician should be able to prevent substitution.
c) The prescribing physician should be notified of any actions toward substitution within 48 hours.
d) The patient, or the patient’s authorized representative, should, at a minimum, be notified of any substitution within 48 hours.
e) The pharmacist and the physician should keep records of any substitution.
f) Biosimilars should stay in the traditional three tiers of the drug formulary which will ensure co-pays and co-insurance payments remain affordable to encourage compliance with treatment, preventing any compromise of the patients’ health and quality of life.
- Letter to Congressman Johnson
Find out more about this issue on the AMA webpage.
The DREAM Act seeks to give immigrant students with good moral character who have lived in the U.S. for at least five years -- and came here before turning sixteen -- the chance to earn legal status after earning a high school degree and completing two years of college or military service in good standing.
On May 11, 2011 the DREAM Act was reintroduced to the Senate, but was not passed into law. Many states however, have passed state laws that are similar to the DREAM Act.
On June 15, 2012 President Obama used his executive power to introduce the Deferred Action for Childhood Arrivals (DACA) program to stop the deportation of young undocumented individuals who match certain criteria previously proposed under the DREAM Act. ARxC supports the full implementation of this program.
Click here to learn more about the bill and how you can get involved in promoting the DREAM Act.